HN 300 Unit 6 Seminar Financing Human Services Madelyn Harvey, PhD

Slides developed by David H. Johnson Millersville University of Pennsylvania Pearson Education 2011

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Access to healthcare is no guarantee of good health  Other factors in good health:  Lifestyle choices (smoking, drinking, etc.)  Obesity  Exercise  Genetics

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Age-related disparities  Race-related disparities  Racial and ethnic disparities in infant mortality and life expectancy

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Social Security Amendments of 1965  Covers virtually all Americans over age 65  Also covers disabled persons receiving SSDI  2008 Federal spending about $468 billion

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Hospital Insurance (HI)  Pays for hospital care, skilled nursing care following hospitalization, some home healthcare, and hospice care  Funded by portion of Social Security Payroll Tax (2.9 percent split between employer and employee)

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Beneficiary pays deductible ($1,068 in 2009)  Medicare pays for remainder of first 60 days in hospital  Medicare pays a portion of days 61 to 150  Medicare pays first 20 days of skilled nursing home care in each benefit period.  Beneficiary pays $ per day for days 21 through 100  No benefits for nursing home care beyond day 100

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Voluntary component which covers physician services and outpatient hospital services, and certain home healthcare services  Covers durable medical equipment  Part A beneficiaries who wish to have Part B must pay premiums

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Gaps in Medicare coverage include prescription drugs, long-term custodial care, catastrophic illness beyond 150 days hospitalization, and co-pays and deductibles  Plans and benefit levels for medigap policies are standardized

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Optional alternative to original Medicare  Health Maintenance Organizations, which also cover some medigaps, for Medicare beneficiaries  Intended to contain healthcare costs, but costs are actually higher than traditional Medicare

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Medicare Modernization Act of 2003 permits Medicare participants to join a private drug plan  Beneficiaries are required to pay monthly premiums, co-payments, and deductibles  Doughnut hole, a large gap in coverage under the original bill, will be eliminated under 2010 healthcare reform law

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Three levels of nursing home care:  Skilled (only type reimbursed by Medicare)  Intermediate  Custodial  Home healthcare alternatives  Medicaid is primary government funding source for LTC

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Medicaid is an entitlement program passed along with Medicare in 1965  Costs are shared between federal and state governments, with each state administering its own program and setting its own rules  Covers about 50 million people

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Any applicant who qualifies must be served  Federal government has over 50 groups that qualify, including aged or disabled poor, children and their parents, children under SCHIP, the medically indigent, and some legal immigrants

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Covers 59 percent of Americans  Premiums are deductible to employer  Premiums are not taxable to employee  Multiple types of plans

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Covers about 9 percent of Americans  Applicants subject to stringent underwriting  Usually higher premiums, deductibles, and co- pays than group plans  Pre-existing conditions may be specifically excluded

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Average of about 46 million Americans  About 15 percent of the population  More than half are “working poor”  Race plays a factor  Ten percent of children under 18

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  More than $2.2 trillion in 2007  Third-party financing and a rapidly aging population both increase demand  Advances in medical technology, expansion of medical facilities, and litigation all increase costs

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  FDR backed off universal health care in Social Security Act of 1935  Private Blue Cross/Blue Shield plans formed in Great Depression  Wages frozen in World War II  Organized labor pushed for fringe benefits in lieu of pay raises  Tax-favored status of employer plans

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  First Lady co-chaired the President’s Task Force on National Health Care Reform  Clinton unveiled Health Security Act in late 1993, which called for regional insurance exchanges  Plan failed to gain passage in late 1994

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Healthcare choice  Pre-existing conditions  Healthcare as a privilege or a right  Rationing of scarce healthcare resources

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Obama took office January 20, 2009  Congress wrestled with various plans for most of 2009  House version passed its bill on November 7, 2009  Senate passed its bill on December 24, 2009  Senate filibuster actually gave negotiating power to Blue Dog Democrats

© 2011 Pearson Education, Inc. All Rights Reserved Social Welfare: Politics and Public Policy, 7e Johnson and DiNitto  Can all Americans be insured?  How does policy influence healthcare?  How do we as a society decide who gets healthcare?